Unhealthy habits often hard to break

When it comes to improving our health, we all know what to do. Exercise. Eat right. Quit smoking. Drink alcohol only in moderation. And wash our hands.

It sounds simple. So why don't more of us do it?

Probably because it isn't so simple. Getting healthy and staying that way often means waging a battle against our genes, our physical and social environments, and a lifetime of bad habits.

For example: Humans are genetically predisposed to being sedentary during adulthood. We favor fatty, calorie-laden foods because that's where our energy comes from. Our caveman bodies strive to store energy for hunting and scavenging food and to fend off now-extinct predators.

But we live in homes, workplaces and neighborhoods that limit physical activity. We have to go out of our way to break a sweat.

In other words, we inhabit Fred Flintstone bodies in a George Jetson world, so overcoming our natural tendencies takes persistent effort. To ensure good health, some experts say, we need to learn the science of behavior change -- that the body part people most need to contend with is not their beer bellies or love handles, but their brains.

Dr. James Prochaska, director of the cancer prevention research center at University of Rhode Island and co-author of the book "Changing for Good," said most behavioral changes, such as losing weight and stopping smoking, involve six stages.

A person who denies or fails to recognize the problem is in a stage he calls pre-contemplation. After that comes contemplation (acknowledging the problem without being ready to change it), preparation (getting ready to change), action (changing behavior) and maintenance (not falling off the wagon). The final stage is termination, meaning the behavior has been tamed and no longer poses a threat.

When people skip straight to action, they are likely to return to their bad habits before long, Prochaska said. Instead, they should think in terms of advancing from one stage to the next.

"Behavior change equals progress, not immediate action," he said.

You might be surrounded by bad food choices, said Kristin Gustashaw, clinical dietitian at Rush University Medical Center. "But if you are ready for change and have developed a plan, you will be able to walk past that food and make the right decisions," she said.

If you lapse -- sneak a smoke or binge on birthday cake -- the goal should be to go back to the plan as soon as possible. "It's OK to make a mistake," Gustashaw said. "That's where most people fall apart; they don't learn from their mistakes and (they) give up."

Another obstacle to change is that we tend to do best when the reward or punishment for our behavior is immediate.

But weight gain -- or weight loss -- can take weeks, even months, to see.

The same principle applies to hand washing. Germs aren't visible to the eye, and most of us don't make the connection between failing to wash and feeling sick a couple of days later.

"If your hands look clean and you don't see others doing it and it's not your habit, you are not likely to do it," said Dr. Robert Kushner, a professor of medicine at Northwestern University's Feinberg School of Medicine and a specialist in healthy lifestyles.

So despite research showing that hand washing reduces diseases such as cold, flu and diarrhea by 30 to 50 percent, many people fail to do it right -- or at all.

About 70 percent of people say they wash their hands after going to the bathroom, according to surveys. But observational studies show that only half of the people who wash use soap. And only half of the soapers washed for 15 seconds or longer, as recommended, said Dr. Charles Gerba, professor of microbiology at the University of Arizona.

"We estimate that only 16 percent (of people who go into the bathroom) wash their hands properly," he said.

Kushner said the arrival of swine flu might cause a spike in hand washing, but probably only temporarily.

"Once the threat is gone, the behavior will be extinguished," he said. "Behaviors have to be reinforced."

"Illness in general becomes like white noise," said Mary Alice Lavin, chief nurse epidemiologist at Rush University Medical Center. "It's only when it's something you haven't heard of before or something with a scary connotation, like flesh-eating bacteria, that people take it seriously."

With any behavior change, you have to want to do it, said Donna Jeffe, research associate professor of medicine at Washington University School of Medicine and director of health behavior and outreach at the Siteman Cancer Center in St. Louis.

Amy Maus, 36, said she enrolled in a weight loss program at Washington University's medical school after she realized the extra pounds were making it difficult to keep up with her 6-year-old daughter. She has lost 45 pounds in eight months and hopes to lose 15 more, which would put her in the normal range for her size.

"We all know we should do better, but in a moment-to-moment situation, it's much easier to choose the fried chicken than the fruit and salad," said Maus, who lives near St. Louis. "It's easier. It's cheaper. It tastes better. It's hard to put aside the short-term, feel-good thing for long-term benefits."

Some experts argue that unhealthy behaviors have more to do with social, cultural and environmental factors than individual preferences.

"We have harmonized to an environment in which we don't have to move around and we can order a pizza and get it in a matter of minutes," Kushner said. "It's not willful misconduct, it's just that's the way society is."

Teaching parents to teach and reinforce good habits early is key, said Stevan Hobfoll, chairman of the department of behavioral sciences at Rush University.

"We have to work with parents to get their kids to eat healthy and exercise because they are starting lifetime patterns," he said. "It's hard to change things once they're set."